Usability of Functional Electrical Stimulation in Upper Limb Rehabilitation in Post-Stroke Patients: A Narrative Review

Stroke leads to significant impairment in upper limb (UL) function. The goal of rehabilitation is the reestablishment of pre-stroke motor stroke skills by stimulating neuroplasticity. Among several rehabilitation approaches, functional electrical stimulation (FES) is highlighted in stroke rehabilitation guidelines as a supplementary therapy alongside the standard care modalities. The aim of this study is to present a comprehensive review regarding the usability of FES in post-stroke UL rehabilitation. Specifically, the factors related to UL rehabilitation that should be considered in FES usability, as well a critical review of the outcomes used to assess FES usability, are presented. This review reinforces the FES as a promising tool to induce neuroplastic modifications in post-stroke rehabilitation by enabling the possibility of delivering intensive periods of treatment with comparatively less demand on human resources. However, the lack of studies evaluating FES usability through motor control outcomes, specifically movement quality indicators, combined with user satisfaction limits the definition of FES optimal therapeutical window for different UL functional tasks. FES systems capable of integrating postural control muscles involving other anatomic regions, such as the trunk, during reaching tasks are required to improve UL function in post-stroke patients.

Automated summary

Stroke leads to significant impairment in upper limb function, and rehabilitation aims to restore pre-stroke motor skills by stimulating neuroplasticity. Functional electrical stimulation (FES) is recognized as a promising supplementary therapy in stroke rehabilitation. This study presents a comprehensive review on the usability of FES in post-stroke upper limb rehabilitation, including factors related to rehabilitation and critical appraisal of outcome measures. The review highlights FES as a promising tool to induce neuroplastic modifications in post-stroke rehabilitation, but the lack of studies evaluating FES usability through motor control outcomes and user satisfaction limits the definition of optimal therapeutical window for different functional tasks. FES systems integrating postural control muscles involving other anatomical regions are needed to improve upper limb function in post-stroke patients.